Medication Therapy Management
Phelps Health Medicare Advantage
If you’re in a Medicare drug plan and you have complex health needs, you may be able to participate in a Medication Therapy Management (MTM) program. MTM is a service offered by Phelps Health Medicare Advantage (HMO) at no additional cost to you. The MTM program is required by the Centers for Medicare and Medicaid Services (CMS) and is not considered a benefit. This program helps you and your prescriber make sure that your medications are working. It also helps us identify and reduce possible medication problems.
To take part in this program, you must meet certain criteria set forth in part by CMS. These criteria are used to identify people who have multiple chronic diseases and are at risk for medication-related problems. If you meet these criteria, we will send you a letter inviting you to participate in the program and information about the program, including how to access the program. Your enrollment in MTM is voluntary and does not affect Medicare coverage for drugs covered under Medicare.
To qualify for Phelps Health Medicare Advantage (HMO) MTM program, you must meet one of the following criteria:
- Determined to be an at-risk beneficiary under the plan’s drug management program OR
- Meet all of the following criteria
- Have at least 3 of the following conditions or diseases: Alzheimer’s disease, Chronic Heart Failure (CHF), Diabetes, Dyslipidemia, Hypertension, Bone Disease-Arthritis-Osteoporosis, Mental health (including depression, schizophrenia, bipolar disorder, and other chronic/disabling mental health conditions), Respiratory Disease (including asthma, chronic obstructive pulmonary disease (COPD), and other chronic lung disorders), Human immunodeficiency virus/Acquired immune deficiency syndrome (HIV/AIDS) or End-Stage Renal Disease (ESRD) AND
- Take at least 8 covered Part D medications, AND
- Are likely to have medication costs of covered Part D medications greater than $1,276 per year.
To help reduce the risk of possible medication problems, the MTM program offers two types of clinical review of your medications:
- Targeted Medication Review (TMR): at least quarterly, we will review all your prescription medications and contact you, your caregiver, your pharmacist, and/or your prescriber if we detect a potential problem.
- Comprehensive Medication Review (CMR): at least once per year, we offer a free discussion and review of all your medications by a pharmacist or other health care professional to help you use your medications safely. This review is provided to you confidentially via telephone by AspenRx. If you or your caregiver are not able to participate in the CMR, this review may be completed directly with your provider. These services are provided on behalf of Phelps Health Medicare Advantage (HMO). This review requires about 30 minutes of your time. Following the review, you will get a written summary of this call, which you can take with you when you talk with your health care provider. This summary includes:
- Medication Action Plan (MAP): The action plan has steps you could take to help you get the best results from your medications.
- Personal Medication List (PML): The medication list will help you keep track of your medications and how to use them the right way.
Use the Personal Medication List (PML) to help you and your health care providers keep track of the medications you are taking.
If you take many medications for more than one chronic health condition contact Phelps Health Medicare Advantage (HMO) to see if you’re eligible for MTM, or for more information, please contact Customer Service at 1(855)752-3796 and (TTY) 711 or 1(800)735-2966.